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Elliott AF, Ng JS, Ojeleye MO, Cuadros J, Prescott SM, Bruder K, Louis-Jacques AL, Kim K, Groer ME. Diabetic Retinopathy during pregnancy in Hispanic women with latent Toxoplasma gondii infection. Eur J Obstet Gynecol Reprod Biol 2024; 294:28-32. [PMID: 38184897 PMCID: PMC11344265 DOI: 10.1016/j.ejogrb.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/01/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
BACKGROUND Retinal photography was performed in pregnancy and postpartum in pregnant Hispanic women with latent Toxoplasma gondii (TG) infection in order to screen for characteristic retinal lesions or the particular scars found in people with active T. gondii infection. A comparison group of TG negative women was included in the study but they did not have retinal photography. OBJECTIVE The goal of the parent study was to assess for adverse pregnancy events and evidence for parasite reactivation in TG positive (TG + ) women, through examination of the eyes for characteristic lesions. Retinal photography, usually at prenatal visits 2 (17 +/- 3.35 weeks) and 3 (26.3+/-1.75) weeks, was done on TG + women. Fifty-six of these women also (43 %) had retinal photography at the postpartum visit. Health and demographic data were obtained at the first prenatal visit for all women. STUDY DESIGN From the 690 recruited at the first prenatal visit, 128 TG- women and 158 TG + women were enrolled in a prospective study through pregnancy and the postpartum. All TG- women (n = 532) provided data at the first prenatal visit and throughout their pregnancy and birth through the EHR. This allowed comparison of health and outcome data for the TG + compared to a larger number of TG- Hispanic pregnant women. RESULTS While there was no evidence of ocular toxoplasmosis during pregnancy, there was a surprisingly large number (42 %) of TG + women with diabetic retinopathy (DR). We also observed that TG + women had a 20 % incidence of gestational diabetes mellitus (GDM) compared to 11.3 % in the TG- women (p = 0.01). At postpartum (mean 5.6 weeks), 23 of 30 women with pregnancy DR showed no DR in the postpartum. CONCLUSIONS No characteristic T. gondii lesions were discovered. Retinal photography serendipitously revealed DR in these T. gondii positive women. It was also found that latent TG infection was associated with increased incidence of GDM. Hispanic pregnant women's increased risk for latent TG infection, GDM and DR are underappreciated. Retinal photography may need to be considered an innovative approach to screening.
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Affiliation(s)
| | - Jason S Ng
- Marshall B. Ketchum University, Southern California College of Optometry, Fullerton, CA 92831, USA
| | | | | | | | - Karen Bruder
- University of South Florida Morsani College of Medicine, Department of OB/GYN, USA
| | | | - Kami Kim
- University of South Florida, Morsani College of Medicine, Division of Infectious Disease and Internal Medicine, USA
| | - Maureen E Groer
- University of South Florida College of Nursing, Tampa, Fl, USA.
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Feng J, Xie X, Teng Z, Fei W, Zhen Y, Liu J, Yang L, Chen S. Retinal Microvascular Diameters are Associated with Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2023; 16:1821-1831. [PMID: 37366485 PMCID: PMC10290843 DOI: 10.2147/dmso.s415667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Objective To investigate the association between retinal microvascular diameters and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). Methods A total of 690 patients with T2DM were included in this retrospective study. Patients were divided into DKD and non-DKD groups according to urine microalbumin/creatinine ratio and estimated glomerular filtration rate. Retinal microvascular diameters were measured by the automated retinal image analysis system. Multivariate logistic regression analysis and restricted cubic splines were used to assess the relationships between the retinal microvascular diameters and DKD in patients with T2DM. Results Multivariate logistic regression showed that widened diameters of retinal venules and narrowed diameters of retinal arterioles were associated with DKD after adjusting for potential confounding variables. There was a significant linear trend between the diameters of superior temporal retinal venula (P for trend < 0.001, P for non-linearity = 0.080), inferior temporal retinal venula (P for trend < 0.001, P for non-linearity = 0.111) and central retinal venular equivalent (CRVE) (P for trend < 0.001, P for non-linearity = 0.392) and risk of DKD in patients with T2DM. The restricted cubic splines showed that narrowed retinal arteriolar diameters, superior and inferior nasal retinal venulas were associated with the risk of DKD in a non-linear fashion (all P for non-linearity < 0.001). Conclusion Wider retinal venular diameters and narrower retinal arteriolar diameters were associated with an increased risk of DKD in patients with T2DM. Widened retinal venular diameters, especially CRVE, superior and inferior temporal retinal venula, were positively associated with an increased risk of DKD in a linear fashion. In contrast, narrowed retinal arteriolar diameters were associated with the risk of DKD in a non-linear fashion.
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Affiliation(s)
- Jing Feng
- Department of Endocrinology, Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei Province, People’s Republic of China
- Hebei Key Laboratory of Metabolic Disease, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Xiaohua Xie
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Zhenjie Teng
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei Province, People’s Republic of China
- Department of Neurology, Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Wenjie Fei
- Department of Endocrinology, Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Yunfeng Zhen
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Jingzhen Liu
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Liqun Yang
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Shuchun Chen
- Department of Endocrinology, Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei Province, People’s Republic of China
- Hebei Key Laboratory of Metabolic Disease, Shijiazhuang, Hebei Province, People’s Republic of China
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Zhang S, Chen R, Wang Y, Hu W, Kiburg KV, Zhang J, Yang X, Yu H, He M, Wang W, Zhu Z. Association of Retinal Age Gap and Risk of Kidney Failure: A UK Biobank Study. Am J Kidney Dis 2022; 81:537-544.e1. [PMID: 36481699 DOI: 10.1053/j.ajkd.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/25/2022] [Indexed: 12/12/2022]
Abstract
RATIONALE & OBJECTIVE The incidence of kidney failure is known to increase with age. We have previously developed and validated the use of retinal age based on fundus images as a biomarker of aging. However, the association of retinal age with kidney failure is not clear. We investigated the association of retinal age gap (the difference between retinal age and chronological age) with future risk of kidney failure. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 11,052 UK Biobank study participants without any reported disease for characterizing retinal age in a deep learning algorithm. 35,864 other participants with retinal images and no kidney failure were followed to assess the association between retinal age gap and the risk of kidney failure. EXPOSURE Retinal age gap, defined as the difference between model-based retinal age and chronological age. OUTCOME Incident kidney failure. ANALYTICAL APPROACH A deep learning prediction model used to characterize retinal age based on retinal images and chronological age, and Cox proportional hazards regression models to investigate the association of retinal age gap with incident kidney failure. RESULTS After a median follow-up period of 11 (IQR, 10.89-11.14) years, 115 (0.32%) participants were diagnosed with incident kidney failure. Each 1-year greater retinal age gap at baseline was independently associated with a 10% increase in the risk of incident kidney failure (HR, 1.10 [95% CI, 1.03-1.17]; P=0.003). Participants with retinal age gaps in the fourth (highest) quartile had a significantly higher risk of incident kidney failure compared with those in the first quartile (HR, 2.77 [95% CI, 1.29-5.93]; P=0.009). LIMITATIONS Limited generalizability related to the composition of participants in the UK Biobank study. CONCLUSIONS Retinal age gap was significantly associated with incident kidney failure and may be a promising noninvasive predictive biomarker for incident kidney failure.
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Affiliation(s)
- Shiran Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, People's Republic of China
| | - Ruiye Chen
- Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, Australia; Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, Australia
| | - Yan Wang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, People's Republic of China
| | - Wenyi Hu
- Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, Australia; Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, Australia
| | - Katerina V Kiburg
- Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, Australia
| | - Junyao Zhang
- Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, Australia
| | - Xiaohong Yang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, People's Republic of China
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, People's Republic of China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, People's Republic of China; Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, People's Republic of China; Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, Australia; Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, Australia.
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, and Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, People's Republic of China
| | - Zhuoting Zhu
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, People's Republic of China; Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, Australia; Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, Australia.
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Kim DS, Shon YS, Hong RK, Oh MK, Cho HY. Microvascular Changes of the Non-surgical Eye after General Anesthesia in Optical Coherence Tomography Angiography. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.8.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To investigate chorioretinal vascular changes in the non-surgical eyes of patients who underwent vitreoretinal surgery under general anesthesia using optical coherence tomography angiography (OCTA).Methods: Data from 40 patients who underwent retinal surgery were retrospectively analyzed. Ophthalmologic examinations (including OCTA) were performed in the morning before and after surgery. The presence of intraoperative hypotension (IOH; mean arterial pressure <70 mmHg) was determined based on medical records. The vessel density of superficial and deep retinal capillary plexus layers, choriocapillaris void features, and thickness of the choroid and retina were quantified after image processing. Associations between retinal OCTA parameters and anesthesia profiles were also assessed.Results: DCP vessel density was increased after general anesthesia (p < 0.05). Among the patients who experienced IOH, there was no statistical difference in chorioretinal vessel parameters before and after general anesthesia. Also, we did not observe a difference in chorioretinal vessel parameters after general anesthesia between healthy patients and patients with chronic disease, including hypertension and diabetes (p > 0.05). The duration of anesthesia and average size of the choriocapillaris void (p < 0.05, r = -0.32), and the intraoperative mean arterial pressure (MAP) fluctuation and DCP, showed statistically significant negative linear correlations (p < 0.05, r = -0.38). The choriocapillaris void size and intraoperative MAP fluctuation also displayed a significant negative correlation (p < 0.05, r = -0.37), while the average size signal void showed a weak positive linear correlation (p < 0.01, r = 0.41; and p < 0.01, r = 0.44, respectively).Conclusions: This is the first study to assess the effects of general anesthesia on chorioretinal vessels using OCTA. The Vessel density of the DCP was significantly increased in the non-surgical eye after total vitrectomy under general anesthesia. Furthermore, we found a correlation between MAP fluctuation and choriocapillaris void features. More studies are needed to confirm and expand on these observations.
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Comparing Measurements of Vascular Diameter Using Adaptative Optics Imaging and Conventional Fundus Imaging. Diagnostics (Basel) 2022; 12:diagnostics12030705. [PMID: 35328258 PMCID: PMC8947285 DOI: 10.3390/diagnostics12030705] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 11/25/2022] Open
Abstract
The aim of this prospective study was to compare retinal vascular diameter measurements taken from standard fundus images and adaptive optics (AO) images. We analysed retinal images of twenty healthy subjects with 45-degree funduscopic colour photographs (CR-2 Canon fundus camera, Canon™) and adaptive optics (AO) fundus images (rtx1 camera, Imagine Eyes®). Diameters were measured using three software applications: the VAMPIRE (Vessel Assessment and Measurement Platform for Images of the REtina) annotation tool, IVAN (Interactive Vessel ANalyzer) for funduscopic colour photographs, and AO_Detect_Artery™ for AO images. For the arterial diameters, the mean difference between AO_Detect_Artery™ and IVAN was 9.1 µm (−27.4 to 9.2 µm, p = 0.005) and the measurements were significantly correlated (r = 0.79). The mean difference between AO_Detect_Artery™ and VAMPIRE annotation tool was 3.8 µm (−34.4 to 26.8 µm, p = 0.16) and the measurements were poorly correlated (r = 0.12). For the venous diameters, the mean difference between the AO_Detect_Artery™ and IVAN was 3.9 µm (−40.9 to 41.9 µm, p = 0.35) and the measurements were highly correlated (r = 0.83). The mean difference between the AO_Detect_Artery™ and VAMPIRE annotation tool was 0.4 µm (−17.44 to 25.3 µm, p = 0.91) and the correlations were moderate (r = 0.41). We found that the VAMPIRE annotation tool, an entirely manual software, is accurate for the measurement of arterial and venular diameters, but the correlation with AO measurements is poor. On the contrary, IVAN, a semi-automatic software tool, presents slightly greater differences with AO imaging, but the correlation is stronger. Data from arteries should be considered with caution, since IVAN seems to significantly under-estimate arterial diameters.
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Arnould L, Guenancia C, Binquet C, Delcourt C, Chiquet C, Daien V, Cottin Y, Bron AM, Acar N, Creuzot-Garcher C. [Retinal vascular network: Changes with aging and systemic vascular disease (cardiac and cerebral)]. J Fr Ophtalmol 2021; 45:104-118. [PMID: 34836702 DOI: 10.1016/j.jfo.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022]
Abstract
For over 10 years, the description of the retinal microvascular network has benefited from the development of new imaging techniques. Automated retinal image analysis software, as well as OCT angiography (OCT-A), are able to highlight subtle, early changes in the retinal vascular network thanks to a large amount of microvascular quantitative data. The challenge of current research is to demonstrate the association between these microvascular changes, the systemic vascular aging process, and cerebrovascular and cardiovascular disease. Indeed, a pathophysiological continuum exists between retinal microvascular changes and systemic vascular diseases. In the Montrachet study, we found that a suboptimal retinal vascular network, as identified by the Singapore I Vessel Assessment (SIVA) software, was significantly associated with treated diabetes and an increased risk of cardiovascular mortality. In addition, we supplemented our research on the retinal vascular network with the use of OCT-A. In the EYE-MI study, we showed the potential role of quantitative characterization of the retinal microvascular network by OCT-A in order to assess the cardiovascular risk profile of patients with a history of myocardial infarction. A high AHA (American Heart Association) risk score was associated with low retinal vascular density independently of hemodynamic changes. Thus, a better understanding of the association between the retinal microvasculature and macrovascular disease might make its use conceivable for early identification of at-risk patients and to suggest a personalized program of preventative care. The retinal vascular network could therefore represent an indicator of systemic vascular disease as well as an interesting predictive biomarker for vascular events.
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Affiliation(s)
- L Arnould
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Centre d'investigation clinique 1432, Dijon, France; Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France.
| | - C Guenancia
- Service de cardiologie, CHU de Dijon, Dijon, France; Laboratoire PEC 2, Dijon, France
| | - C Binquet
- Centre d'investigation clinique 1432, Dijon, France
| | - C Delcourt
- Inserm U1219, équipe LEHA, université de Bordeaux, Bordeaux, France
| | - C Chiquet
- Service d'ophtalmologie, CHU de Grenoble, Grenoble, France
| | - V Daien
- Service d'ophtalmologie, CHU de Montpellier, Montpellier, France
| | - Y Cottin
- Service de cardiologie, CHU de Dijon, Dijon, France
| | - A M Bron
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France
| | - N Acar
- Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France
| | - C Creuzot-Garcher
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France
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Quinn N, Jenkins A, Ryan C, Januszewski A, Peto T, Brazionis L. Imaging the eye and its relevance to diabetes care. J Diabetes Investig 2021; 12:897-908. [PMID: 33190401 PMCID: PMC8169343 DOI: 10.1111/jdi.13462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022] Open
Abstract
Diabetes is a major cause of vision loss globally, yet this devastating complication is largely preventable. Early detection and treatment of diabetic retinopathy necessitates screening. Ocular imaging is widely used clinically, both for the screening and management of diabetic retinopathy. Common eye conditions, such as glaucoma, cataracts and retinal vessel thrombosis, and signs of systemic conditions, such as hypertension, are frequently revealed. As well as imaging by a skilled clinician during an eye examination, non-ophthalmic clinicians, such as general practitioners, endocrinologists, nurses and trained health workers, can also can carry out diabetic eye screening. This process usually comprises local imaging with remote grading, mostly human grading. However, grading incorporating artificial intelligence is emerging. In a clinical research context, retinal vasculature analyses using semi-automated software in many populations have identified associations between retinal vessel geometry, such as vessel caliber, and the risk of diabetic retinopathy and other chronic complications of type 1 and type 2 diabetes. Similarly, evaluation of corneal nerves by corneal confocal microscopy is revealing diabetes-related abnormalities, and associations with and predictive power for other chronic diabetes complications. As yet, the value of retinal vessel geometry and corneal confocal microscopy measures at an individual level is uncertain. In this article, targeting non-ocular clinicians and researchers, we review existent and emerging ocular imaging and grading tools, including artificial intelligence, and their associations between ocular imaging findings and diabetes and its chronic complications.
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Affiliation(s)
- Nicola Quinn
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Center for Public HealthQueen’s University BelfastBelfastUK
| | - Alicia Jenkins
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Center for Public HealthQueen’s University BelfastBelfastUK
| | - Chris Ryan
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
| | - Andrzej Januszewski
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
| | - Tunde Peto
- Center for Public HealthQueen’s University BelfastBelfastUK
| | - Laima Brazionis
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
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Lye WK, Paterson E, Patterson CC, Maxwell AP, Binte Mohammed Abdul RB, Tai ES, Cheng CY, Kayama T, Yamashita H, Sarnak M, Shlipak M, Matsushita K, Mutlu U, Ikram MA, Klaver C, Kifley A, Mitchell P, Myers C, Klein BE, Klein R, Wong TY, Sabanayagam C, McKay GJ. A systematic review and participant-level meta-analysis found little association of retinal microvascular caliber with reduced kidney function. Kidney Int 2021; 99:696-706. [PMID: 32810524 PMCID: PMC7898278 DOI: 10.1016/j.kint.2020.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 01/09/2023]
Abstract
Previously, variation in retinal vascular caliber has been reported in association with chronic kidney disease (CKD) but findings remain inconsistent. To help clarify this we conducted individual participant data meta-analysis and aggregate data meta-analysis on summary estimates to evaluate cross-sectional associations between retinal vascular caliber and CKD. A systematic review was performed using Medline and EMBASE for articles published until October 2018. The aggregate analysis used a two-stage approach combining summary estimates from eleven studies (44,803 patients) while the individual participant analysis used a one-stage approach combining raw data from nine studies (33,222 patients). CKD stages 3-5 was defined as an estimated glomerular filtration rate under 60 mL/min/1.73m2. Retinal arteriolar and venular caliber (central retinal arteriolar and venular equivalent) were assessed from retinal photographs using computer-assisted methods. Logistic regression estimated relative risk of CKD stages 3-5 associated with a 20 μm decrease (approximately one standard deviation) in central retinal arteriolar and venular equivalent. Prevalence of CKD stages 3-5 was 11.2% of 33,222 and 11.3% of 44,803 patients in the individual participant and aggregate data analysis, respectively. No significant associations were detected in adjusted analyses between central retinal arteriolar and venular equivalent and CKD stages 3-5 in the aggregate analysis for central retinal arteriolar relative risk (0.98, 95% confidence interval 0.94-1.03); venular equivalent (0.99, 0.95-1.04) or individual participant central retinal arteriolar (0.99, 0.95-1.04) or venular equivalent (1.01, 0.97-1.05). Thus, meta-analysis provided little evidence to suggest that cross sectional direct measurements of retinal vascular caliber was associated with CKD stages 3-5 in the general population. Hence, meta-analyses of longitudinal studies evaluating the association between retinal parameters and CKD stages 3-5 may be warranted.
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Affiliation(s)
- Weng Kit Lye
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Euan Paterson
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Alexander P Maxwell
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - E Shyong Tai
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ching Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Takamasa Kayama
- Department of Advanced Cancer Science, Yamagata University, Yamagata, Japan
| | | | - Mark Sarnak
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Michael Shlipak
- Division of Nephrology, Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Unal Mutlu
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mohammad A Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Caroline Klaver
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Annette Kifley
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Chelsea Myers
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Barbara E Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | | | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK.
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9
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Paterson EN, Cardwell C, MacGillivray TJ, Trucco E, Doney AS, Foster P, Maxwell AP, McKay GJ. Investigation of associations between retinal microvascular parameters and albuminuria in UK Biobank: a cross-sectional case-control study. BMC Nephrol 2021; 22:72. [PMID: 33632154 PMCID: PMC7908698 DOI: 10.1186/s12882-021-02273-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background Associations between microvascular variation and chronic kidney disease (CKD) have been reported previously. Non-invasive retinal fundus imaging enables evaluation of the microvascular network and may offer insight to systemic risk associated with CKD. Methods Retinal microvascular parameters (fractal dimension [FD] – a measure of the complexity of the vascular network, tortuosity, and retinal arteriolar and venular calibre) were quantified from macula-centred fundus images using the Vessel Assessment and Measurement Platform for Images of the REtina (VAMPIRE) version 3.1 (VAMPIRE group, Universities of Dundee and Edinburgh, Scotland) and assessed for associations with renal damage in a case-control study nested within the multi-centre UK Biobank cohort study. Participants were designated cases or controls based on urinary albumin to creatinine ratio (ACR) thresholds. Participants with ACR ≥ 3 mg/mmol (ACR stages A2-A3) were characterised as cases, and those with an ACR < 3 mg/mmol (ACR stage A1) were categorised as controls. Participants were matched on age, sex and ethnic background. Results Lower FD (less extensive microvascular branching) was associated with a small increase in odds of albuminuria independent of blood pressure, diabetes and other potential confounding variables (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.03–1.34 for arterioles and OR 1.24, CI 1.05–1.47 for venules). Measures of tortuosity or retinal arteriolar and venular calibre were not significantly associated with ACR. Conclusions This study supports previously reported associations between retinal microvascular FD and other metabolic disturbances affecting the systemic vasculature. The association between retinal microvascular FD and albuminuria, independent of diabetes and blood pressure, may represent a useful indicator of systemic vascular damage associated with albuminuria. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02273-6.
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Affiliation(s)
- Euan N Paterson
- Centre for Public Health, Institute of Clinical Science, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA
| | - Chris Cardwell
- Centre for Public Health, Institute of Clinical Science, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA
| | - Thomas J MacGillivray
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - Emanuele Trucco
- VAMPIRE project, Computer Vision and Image Processing Group, School of Science and Engineering (Computing), University of Dundee, Dundee, UK
| | - Alexander S Doney
- Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | | | - Alexander P Maxwell
- Centre for Public Health, Institute of Clinical Science, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA
| | - Gareth J McKay
- Centre for Public Health, Institute of Clinical Science, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA.
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10
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McKay GJ, Paterson EN, Maxwell AP, Cardwell CC, Wang R, Hogg S, MacGillivray TJ, Trucco E, Doney AS. Retinal microvascular parameters are not associated with reduced renal function in a study of individuals with type 2 diabetes. Sci Rep 2018; 8:3931. [PMID: 29500396 PMCID: PMC5834527 DOI: 10.1038/s41598-018-22360-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/22/2018] [Indexed: 01/22/2023] Open
Abstract
The eye provides an opportunistic "window" to view the microcirculation. There is published evidence of an association between retinal microvascular calibre and renal function measured by estimated glomerular filtration rate (eGFR) in individuals with diabetes mellitus. Beyond vascular calibre, few studies have considered other microvascular geometrical features. Here we report novel null findings for measures of vascular spread (vessel fractal dimension), tortuosity, and branching patterns and their relationship with renal function in type 2 diabetes over a mean of 3 years. We performed a nested case-control comparison of multiple retinal vascular parameters between individuals with type 2 diabetes and stable (non-progressors) versus declining (progressors) eGFR across two time points within a subset of 1072 participants from the GoDARTS study cohort. Retinal microvascular were measured using VAMPIRE 3.1 software. In unadjusted analyses and following adjustment for age, gender, systolic blood pressure, HbA1C, and diabetic retinopathy, no associations between baseline retinal vascular parameters and risk of eGFR progression were observed. Cross-sectional analysis of follow-up data showed a significant association between retinal arteriolar diameter and eGFR, but this was not maintained following adjustment. These findings are consistent with a lack of predictive capacity for progressive loss of renal function in type 2 diabetes.
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Affiliation(s)
- Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
| | - Euan N Paterson
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Alexander P Maxwell
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Ruixuan Wang
- VAMPIRE project, Computer Vision and Image Processing Group, School of Science and Engineering (Computing), University of Dundee, Dundee, United Kingdom
| | - Stephen Hogg
- VAMPIRE project, Computer Vision and Image Processing Group, School of Science and Engineering (Computing), University of Dundee, Dundee, United Kingdom
| | - Thomas J MacGillivray
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Emanuele Trucco
- VAMPIRE project, Computer Vision and Image Processing Group, School of Science and Engineering (Computing), University of Dundee, Dundee, United Kingdom
| | - Alexander S Doney
- Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
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11
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Daien V, Granados L, Kawasaki R, Villain M, Ribstein J, Du Cailar G, Mimran A, Fesler P. Retinal vascular caliber associated with cardiac and renal target organ damage in never-treated hypertensive patients. Microcirculation 2018; 24. [PMID: 27987377 DOI: 10.1111/micc.12344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/12/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to assess the relationship between retinal vascular caliber and target organ damage in HT patients. METHODS Data were collected on cardiac, renal, vascular, and retinal variables in 88 consecutive never-treated HT subjects. Retinal vascular calibers were measured from fundus photographs by using a semi-automated computer-assisted program and summarized as CRAE and CRVE. RESULTS Mean CRAE and CRVE were significantly lower in patients with left ventricular hypertrophy (left ventricular mass ≥110 g/m² for women, 125 g/m² for men) than in those with normal left ventricular (CRAE: 129.4±3.7 vs 138.2±2.3 μm; P=.04; CRVE: 195.6±4.4 vs 209.8±2.7 μm; P=.008). CRAE and CRVE were negatively correlated with urinary albumin excretion (β±SE=-15.4±3.2, P<.0001 and β±SE=-11.9±4.4, P=.001, respectively) but were not correlated with estimated glomerular filtration rate (P=.21 and P=.75, respectively), carotid-to-femoral pulse wave velocity (P=.24 and P=.14), or carotid augmentation index (P=.43 and P=.16). CONCLUSION In never-treated HT patients, reduced CRAE and CRVE were associated with cardiac and renal preclinical damage, ie, left ventricular hypertrophy and albuminuria, but not estimated glomerular filtration rate or vascular stiffness.
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Affiliation(s)
- Vincent Daien
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1061, Montpellier, France
| | - Loic Granados
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France
| | - Ryo Kawasaki
- Department of Public Health, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Max Villain
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France
| | - Jean Ribstein
- Université Montpellier 1, Montpellier, France.,Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Guilhem Du Cailar
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Albert Mimran
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Pierre Fesler
- Université Montpellier 1, Montpellier, France.,Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France.,PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier 34295 Montpellier Cedex 5, France
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12
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Heitmar R, Kalitzeos AA, Patel SR, Prabhu-Das D, Cubbidge RP. Comparison of subjective and objective methods to determine the retinal arterio-venous ratio using fundus photography. JOURNAL OF OPTOMETRY 2015; 8:252-257. [PMID: 26386537 PMCID: PMC4591425 DOI: 10.1016/j.optom.2014.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 06/23/2014] [Indexed: 06/05/2023]
Abstract
PURPOSE To assess the inter and intra observer variability of subjective grading of the retinal arterio-venous ratio (AVR) using a visual grading and to compare the subjectively derived grades to an objective method using a semi-automated computer program. METHODS Following intraocular pressure and blood pressure measurements all subjects underwent dilated fundus photography. 86 monochromatic retinal images with the optic nerve head centred (52 healthy volunteers) were obtained using a Zeiss FF450+ fundus camera. Arterio-venous ratios (AVR), central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) were calculated on three separate occasions by one single observer semi-automatically using the software VesselMap (ImedosSystems, Jena, Germany). Following the automated grading, three examiners graded the AVR visually on three separate occasions in order to assess their agreement. RESULTS Reproducibility of the semi-automatic parameters was excellent (ICCs: 0.97 (CRAE); 0.985 (CRVE) and 0.952 (AVR)). However, visual grading of AVR showed inter grader differences as well as discrepancies between subjectively derived and objectively calculated AVR (all p<0.000001). CONCLUSION Grader education and experience leads to inter-grader differences but more importantly, subjective grading is not capable to pick up subtle differences across healthy individuals and does not represent true AVR when compared with an objective assessment method. Technology advancements mean we no longer rely on opthalmoscopic evaluation but can capture and store fundus images with retinal cameras, enabling us to measure vessel calibre more accurately compared to visual estimation; hence it should be integrated in optometric practise for improved accuracy and reliability of clinical assessments of retinal vessel calibres.
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Affiliation(s)
- Rebekka Heitmar
- Aston University, School of Life and Health Sciences, Birmingham, UK.
| | | | - Sunni R Patel
- Topcon Corporation USA, NJ, USA; Toronto Western Hospital, Department of Ophthalmology and Vision Sciences, Toronto, Canada
| | - Diana Prabhu-Das
- Aston University, School of Life and Health Sciences, Birmingham, UK
| | - Robert P Cubbidge
- Aston University, School of Life and Health Sciences, Birmingham, UK
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13
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Seshadri S, Mroczkowska S, Qin L, Patel S, Ekart A, Gherghel D. Systemic circulatory influences on retinal microvascular function in middle-age individuals with low to moderate cardiovascular risk. Acta Ophthalmol 2015; 93:e266-74. [PMID: 25487686 DOI: 10.1111/aos.12594] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/06/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate the relationship between retinal microvascular reactivity, circulatory markers for CVD risk and systemic antioxidative defence capacity in healthy middle-aged individuals with low to moderate risk of CVD. METHODS Retinal vascular reactivity to flickering light was assessed in 102 healthy participants (46-60 years) by means of dynamic retinal vessel analysis (DVA). Other vascular assessments included carotid intima-media thickness (C-IMT) and blood pressure (BP) measurements. Total cholesterol (CHOL), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and blood glutathione levels in its reduced (GSH) and oxidized (GSSG) forms were also determined for each participant, along with Framingham risk scores (FRS). RESULTS Retinal arterial baseline diameter fluctuation (BDF) was independently, significantly and negatively influenced by LDL-C levels (β = -0.53, p = 0.027). Moreover, the arterial dilation slope (SlopeAD ) was independently, significantly and positively associated with redox index (GSH: GSSG ratio, β = 0.28, p = 0.016), while the arterial constriction slope (SlopeAC ) was significantly and negatively influenced by blood GSH levels (β = -0.20, p = 0.042), and positively associated with FRS (β = 0.25, p = 0.009). Venous BDF and dilation amplitude (DA) were also negatively influenced by plasma LDL-C levels (β = -0.83, p = 0.013; and β = -0.22, p = 0.028, respectively). CONCLUSIONS In otherwise healthy individuals with low to moderate cardiovascular risk, retinal microvascular dilation and constriction responses to stress levels are influenced by systemic antioxidant capacity, and circulating markers for cardiovascular risk.
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Affiliation(s)
- Swathi Seshadri
- Vascular Research Laboratory; Ophthalmic Research Group; School of Life and Health Sciences; Aston University; Birmingham UK
| | - Stephanie Mroczkowska
- Vascular Research Laboratory; Ophthalmic Research Group; School of Life and Health Sciences; Aston University; Birmingham UK
| | - Lu Qin
- Vascular Research Laboratory; Ophthalmic Research Group; School of Life and Health Sciences; Aston University; Birmingham UK
| | - Sunni Patel
- Vascular Research Laboratory; Ophthalmic Research Group; School of Life and Health Sciences; Aston University; Birmingham UK
| | - Aniko Ekart
- School of Engineering and Applied Sciences; Aston University; Birmingham UK
| | - Doina Gherghel
- Vascular Research Laboratory; Ophthalmic Research Group; School of Life and Health Sciences; Aston University; Birmingham UK
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14
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Li LJ, Aris I, Su LL, Tint MT, Cheung CYL, Ikram MK, Gluckman P, Godfrey KM, Tan KH, Yeo G, Yap F, Kwek K, Saw SM, Chong YS, Wong TY, Lee YS. Associations of maternal retinal vasculature with subsequent fetal growth and birth size. PLoS One 2015; 10:e0118250. [PMID: 25909909 PMCID: PMC4409150 DOI: 10.1371/journal.pone.0118250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 12/18/2014] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE We aimed to study the maternal retinal microvasculature at mid-trimester and its relationship with subsequent fetal growth and birth size. METHODS We recruited 732 pregnant women aged 18-46 years in the first trimester with singleton pregnancies. All had retinal photography and fetal scan performed at 26-28 weeks gestation, and subsequent fetal scan at 32-34 weeks gestation. Infant anthropometric measurements were done at birth. Retinal microvasculature was measured using computer software from the retinal photographs. RESULTS In multiple linear regression models, each 10 μm narrowing in maternal retinal arteriolar caliber was associated with decreases of 1.36 mm in fetal head circumference at 32-34 weeks gestation, as well as decreases of 1.50 mm and 2.30 mm in infant head circumference and birth length at delivery, respectively. Each standard deviation decrease in maternal retinal arteriolar fractal dimension was associated with decreases of 1.55 mm in fetal head circumference at 32-34 weeks gestation, as well as decreases of 1.08 mm and 46.42 g in infant head circumference and birth weight at delivery, respectively. CONCLUSIONS Narrower retinal arteriolar caliber and a sparser retinal vascular network in mothers, reflecting a suboptimal uteroplacental microvasculature during mid-pregnancy, were associated with poorer fetal growth and birth size.
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Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Izzuddin Aris
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lin Lin Su
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mya Thway Tint
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carol Yim-Lui Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- DUKE-NUS Graduate Medical School, Singapore
| | - M. Kamran Ikram
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Departments of Epidemiology & Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Memory Aging & Cognition Centre, National University Health System, Singapore
| | - Peter Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Keith M. Godfrey
- Medical Research Council Lifecourse Epidemiology Unit and NIHR Southampton, Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | | | - George Yeo
- KK Women’s and Children’s Hospital, Singapore
| | - Fabian Yap
- KK Women’s and Children’s Hospital, Singapore
| | - Kenneth Kwek
- Medical Research Council Lifecourse Epidemiology Unit and NIHR Southampton, Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tien-Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
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15
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Schuster AKG, Fischer JE, Vossmerbaeumer C, Vossmerbaeumer U. Optical coherence tomography-based retinal vessel analysis for the evaluation of hypertensive vasculopathy. Acta Ophthalmol 2015; 93:e148-53. [PMID: 25113436 DOI: 10.1111/aos.12509] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 06/15/2014] [Indexed: 01/18/2023]
Abstract
PURPOSE Evaluation of retinal vessels in cardiovascular disease traditionally relies upon funduscopy, but more recently digital photo analysis has expanded the spectrum. As spectral domain optical coherence tomography (OCT) allows an in-vivo assessment of retinal tissue and its vessels on a histological scale, our study aimed at using this tool for the analysis of the retinal vasculature. METHODS Circumferential peripapillary OCT scans (3DOCT-2000; Topcon Inc., Tokyo, Japan), with centration on the optic nerve head, were taken from 20 eyes (20 participants) with normal blood pressure and 20 eyes (20 participants) with arterial hypertension above 120 mmHg (mean blood pressure). The diameter of all vessels intersecting the scan line was measured in the OCT and used to calculate central vessel equivalents, and the A/V ratios were calculated. Bland-Altman analysis was performed to evaluate reliability. Correlation coefficients were determined for reliability of the method as well as with the individual mean arterial blood pressures. RESULTS Forty eyes (40 participants) were included in the study. Mean arterial blood pressure was 96±4 mmHg in the control group and 132±7 mmHg in the hypertonic group. Mean A/V ratio as determined from OCT scans was 0.82±0.13 (normotonic) versus 0.62±0.11 (hypertonic). A Pearson's correlation coefficient of 0.67 (p<0.001) was determined between A/V ratio and blood pressure. CONCLUSIONS Our results highlight the feasibility of retinal vessel measurements in spectral domain OCT. A relation between mean arterial blood pressure and OCT-based A/V ratio was established. Further research will elucidate influencing factors and provide a broader basis for therapeutic approaches.
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Affiliation(s)
- Alexander Karl-Georg Schuster
- Medical Faculty Mannheim; Mannheim Institute of Public Health, Social and Preventive Medicine; Heidelberg University; Mannheim Germany
| | - Joachim Ernst Fischer
- Medical Faculty Mannheim; Mannheim Institute of Public Health, Social and Preventive Medicine; Heidelberg University; Mannheim Germany
| | | | - Urs Vossmerbaeumer
- Medical Faculty Mannheim; Mannheim Institute of Public Health, Social and Preventive Medicine; Heidelberg University; Mannheim Germany
- Department of Ophthalmology; University of Mainz; Mainz Germany
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16
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Howard KP, Klein BEK, Dreyer JO, Danforth LG, Klein R. Cross-sectional associations of medication and supplement use with retinal vascular diameter in the Beaver Dam Eye Study. JAMA Ophthalmol 2014; 132:23-31. [PMID: 24357405 DOI: 10.1001/jamaophthalmol.2013.6326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Retinal vessel diameters are being measured to examine their relationship with ocular and systemic disease and, in some studies, to calculate the risk of disease. Important factors that directly affect retinal vessel diameters, such as medication use, should be considered when estimating these associations. OBJECTIVE To quantify the association between selected medications and supplements and retinal vessel diameters. DESIGN, SETTING, AND PARTICIPANTS In a prospective cohort investigation, 4926 participants (aged 43-86 years at baseline) in the Beaver Dam Eye Study were evaluated every 5 years during 20 years of follow-up from 1988 to 2010. MAIN OUTCOMES AND MEASURES Central retinal arteriolar equivalent and central retinal venular equivalent measured from the Early Treatment Diabetic Retinopathy Study fundus photograph field 1. RESULTS After Bonferroni correction, the use of any blood pressure medication (β = 0.75; P = .04), specifically calcium channel blockers (β = -1.02; P < .001), was significantly associated with wider central retinal arteriolar equivalent adjusting for refraction, photograph focus, age, systolic blood pressure, height, examination phase, educational level, smoking and drinking histories, and presence of diabetes mellitus and emphysema. Use of prostaglandin analogues was marginally associated with narrower central retinal arteriolar equivalent (β = -2.04; P = .09); β-blockers (β = -1.02; P = .10) and oral corticosteroids (β = 2.13; P = .07) were marginally associated with changes in the central retinal venular equivalent. CONCLUSIONS AND RELEVANCE Several medications are associated with central retinal arteriolar and venular equivalents. Prostaglandin analogues, calcium channel blockers, and oral corticosteroids have the largest relative effects. After Bonferroni correction was applied, the use of calcium channel blockers was most strongly associated with change in the central retinal arteriolar equivalent. The presence of factors that are associated with retinal vessel diameters should be considered when using retinal vessel diameter as an outcome or when using these measures to assess the risk of systemic or ocular disease.
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Affiliation(s)
- Kerri P Howard
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jennifer O Dreyer
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison
| | - Lorraine G Danforth
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison
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17
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Daien V, Carriere I, Kawasaki R, Cristol JP, Villain M, Fesler P, Ritchie K, Delcourt C. Retinal vascular caliber is associated with cardiovascular biomarkers of oxidative stress and inflammation: the POLA study. PLoS One 2013; 8:e71089. [PMID: 23923054 PMCID: PMC3724806 DOI: 10.1371/journal.pone.0071089] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/24/2013] [Indexed: 12/30/2022] Open
Abstract
Purpose Retinal vascular caliber has been linked with increased cardiovascular risk and is predictive of cardiovascular pathology, including stroke and coronary heart disease. Oxidative stress, as well as inflammatory mechanisms, plays a major role in the pathogenesis and progression of atherosclerosis, plaque rupture and vascular thrombotic propensity. The purpose of this study is to explore the relationship between retinal vascular calibers and biomarkers of oxidative stress and inflammation, in subjects free of cardiovascular pathology. Patients and Methods Cross-sectional analysis from a community-dwelling cohort comprising 1224 individuals aged 60 years and over, without a history of coronary or peripheral artery disease or stroke. Retinal vascular caliber was measured from fundus photographs using semi-automated standardized imaging software. Oxidative stress was evaluated using plasma superoxide dismutase 2 and glutathione peroxidase (GPx-3) activities, and inflammatory state was assessed using plasma high sensitivity C-reactive protein (hsCRP) and orosomucoid. Results In a multivariate model controlling for cardiovascular risk factors, larger retinal arteriolar caliber was independently related to higher level of GPx-3 activity (p = 0.003) whereas larger venular caliber was associated with higher levels of hsCRP (p = 0.0001) and orosomucoid (p = 0.01). Conclusion In the present study, biomarkers of oxidative stress regulation and inflammation were independently associated with retinal vascular calibers. This suggests that an assessment of retinal vessels may offer early and non-invasive detection of subclinical vascular pathology.
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Affiliation(s)
- Vincent Daien
- Inserm, U1061, Montpellier, France
- Université Montpellier 1, U1061, Montpellier, France
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France
| | - Isabelle Carriere
- Inserm, U1061, Montpellier, France
- Université Montpellier 1, U1061, Montpellier, France
| | - Ryo Kawasaki
- Department of Public Health, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Jean-Paul Cristol
- Department of Biochemistry, Lapeyronie Hospital, Montpellier, France
| | - Max Villain
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France
| | - Pierre Fesler
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Karen Ritchie
- Inserm, U1061, Montpellier, France
- Université Montpellier 1, U1061, Montpellier, France
- Faculty of Medicine, Imperial College, St Mary's Hospital, London, United Kingdom
| | - Cecile Delcourt
- Inserm, Centre Inserm U897-Epidemiologie-Biostatistique, Bordeaux, France
- Université Bordeaux, ISPED, Bordeaux, France
- * E-mail:
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